The Role of Cannabis in Treating Anxiety: An Update

Michael Van Ameringen; Jasmine Zhang; Beth Patterson; Jasmine Turna


Curr Opin Psychiatry. 2019;33(1):1-7. 

In This Article

Risks of Cannabis use: Dependence and Anxiety

Excessive cannabis use may result in the development of CUD, which includes symptoms related to cannabis dependence and other associated problems. Recent data show treatment demand for cannabis problems to have increased by 76% between 2006 and 2016 in 25 European countries, which suggests that CUDs are on the rise.[5] Medical cannabis use has been identified as a prominent risk factor, as medical cannabis users demonstrate elevated rates of CUD.[42,43] This raises the question of whether cannabis dependence affects susceptibility and other associations with anxiety disorders. A recent review suggests that higher cannabis use, especially at a level of disordered use, is associated with a higher risk of anxiety.[5] Evidence from the National Comorbidity Survey[2] suggested that subjects with cannabis dependence were twice as likely to be diagnosed with an anxiety or mood disorder; specifically, the comorbidity between cannabis dependence and anxiety disorders ranged from 6.9% to 29%, which is higher than those without cannabis dependence. In a separate large-scale Australian survey, cannabis use was found to be unrelated to anxiety after adjusting for demographic characteristics, other substance use, and personality traits.[44] Furthermore, Agosti et al.[45] reported a considerable number of patients to have developed anxiety disorders prior to the onset of cannabis dependence symptoms, suggesting that some of patients may have self-prescribed cannabis to treat their anxiety. In support of this, Buckner et al.[46] found social anxiety to be an independent risk factor for cannabis dependence. As such, Manthey[5] suggests that a causal relationship between cannabis use and long-term anxiety disorders is unlikely, given contradictory evidence from various studies. Other risk factors for cannabis dependence include the use of other substances, including tobacco, male sex, high stress, high impulsivity, and low self-esteem.[43,47,48] Older age at diagnosis has also been identified as a risk factor as has earlier age of cannabis use initiation.[43]

Investigations have also been conducted on the association between cannabis and specific manifestations of anxiety, including panic attacks. Although no recent studies have been published, previous survey studies have suggested a positive relationship between cannabis use and panic attacks/panic disorder.[49,50] Cannabis use has been significantly associated with an increased odds of lifetime panic attack history, and lifetime and past-year diagnosis of panic disorder.[49] In addition, a prospective adolescent study found that cannabis use and dependence were significantly associated with increased odds of developing panic attacks and panic disorder.[51] Cannabis has also long been associated with inducing panic attacks.[52,53] Some researchers have hypothesized that there may be mechanistic differences between ordinary panic attacks and those induced by cannabis; in particular that the function of the hypothalamics–pituitary–adrenal (HPA) axis may differ between panic disorder and cannabis-induced panic attacks.[53] This hypothesis remains under examination.